1. HIV ASSOCIATED MALIGNANCIES
Dr. G. VENKATESAN
Asst. Surgeon
GHTM, Tambaram

2. OPPORTUNISTIC MALIGNACIES
Kaposi sarcoma
Lymphoma of Brain
Primary
Secondary
NHL HL
Burkitt Lymphoma
Cervical dysplasia / Ca
Anal dysplasia / Sq cell Ca

3. KEY POINTS High index of clinical suscipion.
Physicians must think in terms of not only the possibility of opportunistic infections but also malignancies when diagnosing and treating HIV positive patients.
As CD4 count - occurrence as well as aggressiveness of the malignancies

4. CASE STUDY
A 25 year- old HIV positive male patient is having difficulty in breathing, coughs with expectoration and reports having no appetite.
What preliminary diagnosis would you make for this patient?

5. Cont…
You take an x-ray of the patient and discover a mediastinal mass.
Given this new information, what diagnosis would you make for this patient?
What other possible diagnoses could you make?

6. KAPOSI’S SARCOMA (KS)
Multicentric Neoplasm consisting of over growth of venular capillary endothelium
Can occur as potentially occult lesions
Unusual and rare before AIDS
Most common in North America and Europe (HOMOSEXUALS)
Closely linked with Human Herpesvirus HHV8

8. Cont… Most common site – skin, Lymph nodes 1 CD4 Count X
Others – Mouth, Hard palate,Tip of nose, Penis, lower legs
GIT, Liver, spleen, Lungs.
Never involves Brain.
Colourful lesions – Red, Violet, Brown, Black
Well circumscribed, flat / raised. 1
CD4 Count X
Aggressiveness

9. DIAGNOSIS Made on Clinical suspicion and confirmed by HPE
Should be differentiated from bacillary angiomatosis

10. TREATMENT Single lesions – RT
Multiple – Vincristine, Bleomycin, Doxorubicin
Regress with HAART

11. IYMPHOMA
Primary CNS lymphoma
NHL HL
Burkitt lymphoma

12. PRIMARY CNS LYMPHOMA 2nd most common SOL in HIV
Strong association with EBV
CD4 < 50
Difficult to diagnose with imaging
Presentation – focal seizures, Resistant fever
Lesions – more often solitary
- Deep in white matter

14. Cont. . . Confirmed by biopsy
PCR assay of CSF for EBV DNA (90%)
DD – Toxo, Bact. Abscess, Cryptococcoma, Tuberculoma, Nocardia
RT – difficult to treat.

15. SYSTEMIC LYMPOMA
Non Hodgin L
Hodgin L
Burkitt L

16. NON HODGIN LYPHOMA B Lymphocytes – 80% T Lymphocytes – 20%
Tend to occur largely at Extranodal sites – most in CNS, Bone marrow, GIT, Liver, Lungs
Confirmation by HPE
Treatment – Chemotheraphy, Radiotheraphy

17. HODGIN LYMPHOMA 5 fold in HIV
More of mixed cellularity / lymphocyte depleted subtypes
Not in CDC definition of AIDS
Present in advanced stage of AIDS

18. BURKITT LYMPHOMA Small non-cleaved cell lymphoma
Most in years (young)
C-myc translocation from Ch 8 to Ch 14/22
EBV Positive
Chemotherapy

19. CERVICAL DYSPLASIA/ Ca
Common cancer in women – 80% of all GYN cancers
Type 2 HSV
HPV – 16, 18, 31, 33
High risk factors
Multiple partners or monogamous women whose partner have multiple partners.
Early age at first sexual intercourse
Family size
Heavy smoking
OCP > 8 years
Lower socioeconomic status

20. Cont… Erosion, Endocervicitis, Ectropion – not precursors of CA
Reserve cells beneath columnar EPI at SC jn – from metaplastic cells (becomes mature cells)
Metaplasia
Columnar Squamous
Epidermidization
Some M cells become atypical
Atypical metaplasia – precursor of dysplasia

22. Cont… Dysplasia – altered / disorderly arrangement of cells.
CIN I – Mild
CIN II – MOD
CIN III – Sev. - CA in situ
Abnormal vaginal bleeding, discharge, postcoital bleeding, lower abd – pain
O/E – red, friable, exophytic lesion or ulcer, bleeds on touch

23. INV
Screening - Papanicolaou smear – standard single most effective screening test
Colposcopy
Cericography
Cone – BX
Punch BX
Large loop excision of transformation zone (LLETZ)
Other investigations

24. Treatment Surgery Conization Hysterectomy BSO Radical H
Pelvic exenteration
Cryosurgery
Laser surgery
Loop electrosurgical excision procedure (LEEP)

25. Cont. . . RT – Brachy therapy
- Intracavitary radiation (Cobalt, Caesium, selectron)
Chemo – Cisplatin, Ifosfamide(70% response)

26. Thank you